MR G ROWE
In systems theory there is a distinction drawn between complicated and complex problem. In a complicated system there are a number of interacting variables and factors which make deciding upon the optimum course of action a challenge. However, in a complicated system there are clear causes and effects which means, with expert insight, solutions can generally be found which go towards solving the problem - or at least preventing it from becoming worse. In a complex system the relationship between cause and effect is unclear, even to experts in the field, with the optimum solution only revealing itself in hindsight as the situation progresses. In a complex situation there is a very real possibility of well-meaning actions leading to negative outcomes and a deterioration in the situation. In this opinion piece I will analyse where we are with the 2019 CoronaVirus strain, the international and government responses and the extent to which we should be concerned given the currently available evidence.
The seasonal flu is an example of a complicated problem, every year scientists produce a vaccine, based upon the probability of certain strains causing an epidemic, and this is given to vulnerable groups in society eg. older people and those with lung conditions. The influenza vaccine has an estimated effectiveness of 40-60% each year and its use for vulnerable groups is supported by a wide range of research evidence and disease modelling. The causes of flu are well established, the mutation rate of the influenza virus and the effect of mutations on its virulence and mortality rate have become well established. With our collective memories of the 1919 Spanish Flu pandemic vast amounts of resources are put into influenza research and when a potentially concerning strain of flu emerges - such as the H1N1 Swine Flu or H5N1 Bird Flu - systems are in place to rapidly produce a vaccine, distribute appropriate antiviral drugs and trigger appropriate public health interventions to limit its effects.
In COVID-19 we have a complex problem, the virus has zoonotically emerged from a bat reservoir to infect humans in an alarmingly short time. As yet it is still relatively unstudied - we do not know with certainty the immediate animal source, its mortality rate, how to vaccinate against it, the exact incubation period or method of transmission. This creates a scenario where cause and effect are not well established and well meaning actions can inadvertently increase the spread of the infections. Certain decisions, for example asking those testing positive to self-isolate and closing down the wet-market where the original infection most likely occurred are common-sense interventions which will slow the disease progression. However decisions to close businesses while well-intentioned could inadvertently increase virus transmission as those who are infected but asymptomatic during the incubation phase travel are unlikely to self-isolate, as they are unaware that they are affected, and may use the time gained to travel more widely or go to more public places than they otherwise would have done. Likewise the promotion of wearing a mask has been shown to be generally ineffective in preventing infection in the general public who often use the incorrect grade of mask and fit them incorrectly. The promotion of mask use has led to shortages for healthcare workers in some regions compromising medical care for CoronaVirus patients! These examples illustrate the risk of decisions designed to mitigate against a threat where causal relationships have not been widely studied and established. In addition many of the steps designed to control the disease spread are certain to have an impact upon National economies and the World economy potentially leading to economic recession or even depression - which have themselves been established as factors which increase all-cause mortality. The opportunity cost of treating COVID-19 is also something which has not been widely considered - how many people suffering other medical conditions will fail to be given life-saving treatment if the NHS and healthcare systems worldwide are stretched by Corona to the point that treatment is less accessible to those with other conditions?
It is human nature for us to fear a new existential threat more than a familiar one - COVID-19 is widely regarded as a more serious threat to humanity than the influenza virus at the current time. For older people (particularly men over 75 and those with other health conditions) Corona is a serious threat as the novel virus is more likely to progress to life-threatening pneumonia. Although to put this into context, all-cause mortality is higher in this group meaning many other conditions are also more likely to be fatal to them than the general population.
At the time of writing 3,214 deaths have been attributed to COVID-19 whereas in 2019 99,000-200,000 people around the world died from influenza. Corona appears to be less virulent than flu but with a higher mortality rate of 1-3%. However, the true mortality rate may well be lower than this as it is reported to cause only mild illness in a large proportion of people infected - patients who will not seek medical treatment and not be categorised as having contracted the virus. There is also the possibility that the new virus evolves rapidly to become more virulent or have a higher mortality rate however, the current evidence is that this is not happening with little variability in cases detected around the world.
So what should we do about CoronaVirus and how will conceptualising the outbreak as a complex problem aid our response? Firstly, the low degree of knowledge of the virus and how it spreads means that I believe the most draconian public health responses, with their associated consequences, are not justified unless there is a significant change in the viruses characteristics. Extreme and socially disruptive attempts to combat the virus may cause more severe effects upon individuals and economies than the disease itself or, even, inadvertently increase the rate at which the pandemic spreads. Secondly, governments and public bodies should carefully monitor the situation, disseminating information and resources in response to the severity of the threat. There is a very real chance that disproportionate responses will lead to a level of hysteria which hampers efforts to inform the public with a scientific and evidence-based understanding of the situation and the treat presented.
Personally I am going to make sure I surgically wash my hands more frequently than I otherwise would do (including before eating or touching my mouth), avoid touching handrails and other communal surfaces where possible, minimise the time I spend in busy communal areas and regularly reassess while keeping abreast of future developments in the virus outbreak on the news. I do not believe going further than this, without Corona symptoms, is justified by the evidence currently available or likely to significantly reduce the chance of infection at the current time.
G.Rowe
Head of Biology
If you wish to find out more about COVID-19 to make your own mind up I suggest these sources:
https://www.nhs.uk/conditions/coronavirus-covid-19/
https://www.who.int/health-topics/coronavirus
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses
https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public
https://www.bbc.co.uk/news/business-51706225
https://www.bbc.co.uk/news/health-51674743